Gentle Yoga (East)

Gentle Yoga Registration (East Portland)

Tuesdays/Thursdays, 11:00 a.m.-12:00 p.m. PT
Name*

First NameLast Name
Email*
example@example.com
City, State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about us?*
Are you a Providence employee?*

YesNo
Optional Demographic Information

Would you consider helping us continue to offer, improve, and enhance our free community classes and programs? This demographic information will help us improve our ability to serve our participants, enhance funding, and perform research around healthy lifestyle behaviors and our community-centered programming. All research data will be de-identified. We do not sell or give your information to third parties.
Would you mind answering our demographic questions?*

Happy to answer!No thanks.
Age
What race(s) do you consider yourself to be?

Alaska NativeAmerican IndianAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhite/CaucasianSome other racePrefer not to sayUnknown
Do you consider yourself to be Hispanic or Latino?
How do you identify?

ManNon-binaryWomanPrefer to self-describe
PARTICIPANT WAIVER

Please read the information below and then check the box indicating your understanding.
By checking the box below, you understand the following: Thank you for participating in the classes offered by Basecamp Prevention + Wellness, part of the Providence Heart Institute of Oregon. By participating, you understand that these classes may include exercises that may increase your heart rate and may increase your blood pressure. Your choice to participate certifies that you have no known ailment, disease, or organic condition, which would make your participation in these classes dangerous to your health. Please stop participation in these classes if any changes in your health or physical condition affects your ability to exercise (pregnancy, injury, illness, etc.). Your participation acknowledges that you have consulted with or had the opportunity to consult with your physician concerning your participation in these classes.
Participant Waiver Acknowledgment*

I understand
If you have questions or comments regarding this registration or Gentle Yoga, please send us an email.
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Gentle Yoga Registration (East Portland)

PARTICIPANT WAIVER